云南省育龄夫妇接受孕前保健服务的依从性研究

目的：以云南省4个项目县育龄夫妇接受一级干预措施的依从性和影响因素为重点,从服务的提供和利用进行分析,为提高孕前保健服务依从性提供建议。方法：采用定量、定性研究方法,根据各县填报的《出生缺陷预防开展工作情况调查》了解育龄群众接受孕前保健服务的情况,现场分别对4个县的335名公众及363名目标人群进行面对面问卷调查,访谈9组育龄群众共计84人。结果：问卷调查显示目标人群中有超过95%者近期接受了孕前保健服务并感到满意或非常满意,健康教育参与率为83.44%,叶酸增补率为58.27%,孕前检查率为71.39%;县、乡两级计划生育服务提供者对孕前检验项目的临床意义和结果能否进行合理、准确的解释和随后处理,以及如何适时指导育龄夫妇转诊等均成为与依从性密切相关因素,说明即使是免费服务,个人的知识、态度和社会因素都可能成为依从性的主要影响因素。结论：从服务提供者和服务对象的角度,探讨依从性主要影响因素,并有针对性的提出改善措施,促进育龄群众对孕前保健服务的利用。     

云南省生殖道感染综合防治中服务利用的定性研究

目的:对目标人群利用生殖道感染防治服务的情况和需求进行分析,提出改善生殖道感染综合防治的建议。方法:采用定性研究的方法,对云南省弥勒、陇川两个试点县的县、乡、村生殖健康服务机构的管理者、服务提供者和社区群众进行了小组访谈及个人访谈。结果:服务对象认为对现有生殖道感染防治服务利用不足,有进一步的需求;服务提供者通过项目实践知识和技能得到提升,但操作的规范性有待加强;在提供常规性病的医疗服务方面,还需加强能力建设,完善转诊制度。结论:生殖道感染的有效控制需要从政策制定、服务提供、社区参与、个人行为等方面入手,制定综合防治规划。生殖道感染防治与计划生育/生殖保健相结合的综合防治措施具有非常好的社会效益比。     

孕前优生健康检查风险评估质量核查的定性研究

目的作为评价5省10县县级妇幼计生服务机构孕前风险评估质量内容之一,主要通过定性研究了解管理者和服务提供者的经验和做法以及影响风险评估质量的主要因素,为进一步规范开展孕前优生项目风险评估和咨询指导提供建议。方法分别于2015年9月-2015年12月,共对72名管理者、服务提供者采用专题小组讨论、个人深入访谈和现场观察的方法进行定性调查。结果通过项目的带动,服务提供者的知识和技能得到全面提升,但临床整体思路的不足是影响风险评估能力的主要因素。现有的技术服务水平与育龄群众对规范、高质量孕前优生健康检查服务的需求尚有差距。结论有针对性的连续的高质量培训,是不断提升服务提供者的全面临床综合素养和能力,保证育龄群众获取规范实用风险评估报告,直接体验到重大公共卫生服务的服务效果的重要途径。     

孕前优生干预措施落实情况的调查分析

目的:分析育龄群众孕前优生干预措施落实情况,探讨改进措施。方法:在云南省2018年开展孕前优生等公共卫生项目的25个县(市、区),以育龄群众、管理者和服务提供者为对象开展现场定量、定性研究。结果:调查的171名育龄群众中风险暴露者占50.9%,风险分类前3位分别是营养生活方式(33.3%)、慢性病(28.6%)、感染性疾病(21.4%);风险暴露人群落实孕前优生干预措施占66.7%。能否获取面对面的咨询指导,知识、态度和行为,供方的服务质量、技能和环节等均影响育龄群众孕前优生干预措施的落实。结论:面对面告知信息、传授技能,促进育龄群众知识、态度和行为的真正改变,以及通过提高服务质量和改善服务环节,提出适宜的干预措施或转诊建议,为育龄夫妇以最佳健康状态进入妊娠阶段创造良好环境。     

上海市长宁区新婚对象孕前保健知识和服务需求调查

目的:了解长宁区新婚对象影响孕前知识和行为情况的因素以及他们对孕前保健服务的需求,为针对性地开展孕前保健服务、完善经济发达地区孕前保健实施策略提供依据。方法:随机抽取2010年12月~2011年7月到长宁区民政局进行婚姻登记且自愿接受调查的1 030名新婚男女为研究对象,采用自制问卷进行面对面调查获取孕前保健知识和意向情况。结果:①孕前保健知识得分方面男女差异有统计学意义(P0.05);②调查对象对孕前保健的态度92.7%人赞成做孕前准备,91.0%人支持做双方孕前体检;③对孕前营养知识(82.9%)、遗传与优生知识(80.9%)和生育基本知识(80.6%)的需求占前3位;④82.5%愿意接受发放阅读资料作为宣教途径。结论:新婚夫妇认为孕前保健知识宣教及孕前检查是有必要的;宣教的方式应以发放阅读资料为主,内容主要应集中在营养、遗传与优生和心理准备上。     

云南省农村育龄妇女增补叶酸影响因素调查

目的:探讨云南省农村育龄妇女围孕期及妊娠期增补叶酸的现状及影响因素。方法:采用整群随机抽样法抽取泸西县符合条件的共2538位农村孕产妇进行问卷调查。应用单因素分析和多因素非条件logistic逐步回归法寻找围孕期及妊娠期增补叶酸的影响因素。结果:51.7%的调查对象在围孕期或妊娠期补充过叶酸。多因素分析显示影响农村育龄妇女增补叶酸的因素有妻子的受教育年限(OR=0.53)、家庭去年的总收入(OR=2.222)、孕前健康检查状况(OR=3.397)、家中有无优生宣传资料(OR=1.957)、优生知识是否及格(OR=2.380)、是否知道叶酸的作用(OR=88.015)。结论:健康教育应当成为云南广大农村增补叶酸服务的先导,孕前保健服务应当是叶酸推广和其他生殖保健技术服务的结合。在叶酸的推广中,计划生育宣传员发挥着重要作用。     

深圳市宝安区流动人口孕前保健依从性的影响因素及模式探索

目的对深圳市宝安区流动人口孕前保健依从性进行调查,分析其影响因素,对提高流动人口孕前保健依从性的模式进行探索,为优生优育提供依据。方法选取深圳市宝安区流动人口1 300名女工进行研究,采用自制调查问卷进行调查,观察流动人口孕前保健依从性的影响因素;对相关因素进行单因素及多因素Logistic回归分析。647名愿意接受干预模式为观察组,653名不愿接受干预措施为对照组。观察组实施孕前保健系统知识培训、系统化管理模式及现代化信息管理技术进行干预,比较两组孕前保健依从性情况,分析统计参加孕前保健和未参加孕前保健的女工计划妊娠率、不孕不育发生率、流产率、合并症发生率和出生缺陷儿等指标的差异性。结果 1 300名调查对象收回有效调查问卷1 279份,经单因素分析发现:不同年龄阶段、不同收入、不同职业人群孕前保健参与率比较,差异无统计学意义(P0.05);但不同文化程度人群孕前保健参与率比较,差异有统计学意义(P0.05);经多因素Logistic回归分析发现,不同文化程度是影响孕前保健参与率的独立危险因素(P0.05)。观察组孕前保健的依从性高于对照组(P0.05);参加孕前保健者的计划妊娠率高于未参加孕前保健者,流产率、合并症发生率和出生缺陷儿低于未参加孕前保健者,差异均有统计学意义(P0.05)。结论影响流动人口孕前保健依从性的影响因素较多,应加强卫生服务系统建设,做好孕妇信息跟踪,定期进行相关培训,保证孕妇孕期保健的依从性,为优生优育提供基础。     

外出务工妇女与户籍妇女孕前保健知识知晓及服务获得情况比较分析

目的:调查外出务工育龄妇女对出生缺陷预防和孕前优生健康检查的知晓和服务获得状况,为建立适宜高效的一级预防干预模式提供技术支持和依据。方法:对2013年3~8月在广东部分地区计划生育技术服务机构接受孕前优生健康检查服务的育龄妇女进行出生缺陷预防知识和孕前优生健康检查服务相关问卷调查。结果:调查对象外出务工组378名,户籍地常住组401名。779名对象年龄25.19±3.34岁。两组对象年龄、受教育程度和职业构成均无统计学差异(P均0.05)。调查对象对于出生缺陷的原因和预防措施及孕前优生服务项目等了解不全面。户籍地常住组对象对于如何获取这些免费服务的认知程度以及对孕前优生健康检查中地中海贫血筛查的意义知晓度明显高于外出务工组(P均0.05)。户籍地常住组对象出生缺陷预防知识得分高于外出务工组,且得分与对象受教育程度明显相关。结论:加强流动人口流入地出生缺陷相关知识科普宣传和孕前保健服务的提供,有利于提高目标人群出生缺陷一级预防效果。     

上海某区新婚夫妇孕前保健相关知识和态度调查

目的：了解上海市新婚夫妇的孕前保健态度及其知识水平。方法采用问卷调查的方法，了解1025名新婚夫妇对孕前保健的知晓和态度情况，以及对应孕前保健知识的水平。结果在受访对象中98．5％有兴趣接受孕前保健服务，真正了解免费孕前保健服务者占61．8％。受访者的67．8％愿意为孕前保健服务支付500元以下的费用，最受欢迎的获取知识的来源是妇产科医生，占受访者的56．1％。在孕前保健知识方面，男女之间知识水平得分比较差异有统计学意义（t＝5．385，P＜0．05）。不同年龄组、不同文化程度、不同收入之间受访者保健知识得分比较差异均有统计学意义（ F值分别为3．108、3．878、8．346，均P＜0．05），而不同职业之间比较差异无统计学意义（P＞0．05）。结论目前孕前保健的接受度较高，但孕前保健优生知识不全面，可以根据不同对象提供个性化的服务和全面的优生知识，从而提高孕前保健服务效率。     

农村育龄妇女孕前保健服务利用影响因素分析

目的调查农村育龄妇女孕前保健服务利用现状及影响因素,为进一步完善农村孕前保健实施策略提供依据。方法采用分层抽样方法,选取1 227名农村育龄妇女为研究对象,采用自制问卷进行入户调查获取孕前保健服务利用相关情况。结果孕前保健服务利用率为37.5%;妇科检查、白带常规、血型、血常规、B超、TORCH感染监测、输血前3项、染色体监测等检查项目利用率分别为36.6%、35.4%、30.1%、31.5%、28.4%、24.0%、19.2%、1.2%;多因素Logistic回归分析显示,年龄、经济收入、医疗保障状况、就医便利程度、孕前保健意识、孕前保健知识及知识获取途经对孕前保健服务利用率有明显影响(P<0.05)。结论农村孕前保健服务利用率较低;人口学因素、孕前保健意识及认知因素、孕前保健宣传途径是农村育龄妇女利用孕前保健服务的重要影响因素。     

Extending Medicaid coverage for family planning services: Alabama's first four years

OBJECTIVES: This study examines whether Alabama's Medicaid family planning demonstration program reaches a different segment of the population than the health department-based Title X family planning program, whether service use rates differ across clients using care within and outside of the Title X provider system, and whether additional risk assessment and care coordination services provided by health department personnel increase the likelihood that family planning clients return for follow-up visits over time. METHODS: Administrative data from four years of operation of the program were used to examine characteristics of the clientele, differences in services used across provider types included in the program, and the impact of risk assessments and care coordination on return visit rates. RESULTS: The number of family planning service users increased dramatically over the four-year period, but were more similar demographically to Title X clients than to Medicaid maternity clients. Growth was greatest among clients of non-Title X providers. Newly covered services, including risk assessments and care coordination, were available mostly to Title X clients, and these services were associated with a greater likelihood that clients returned for care in subsequent years. CONCLUSION: Expanded provider networks can increase the number of low income women using family planning services while risk assessment and care coordination can improve the effectiveness of these services. However, enhanced services may not be equally available across provider systems. Additional outreach efforts are needed to reach women eligible for publicly supported family planning services who are not currently using these services.     

孕前优生信息化服务模式的探索研究

目的:探索利用现代化信息技术手段开展孕前保健服务的新模式,提高我国计划生育工作的管理水平和服务水平。方法:将信息技术手段应用在出生缺陷一级预防领域,对传统孕前保健服务模式面临的问题提出解决对策,形成统一规范的信息工作平台,采用建立电子生殖健康档案的方法探索符合我国人口现状和特征的信息化服务模式。结果:以信息化手段开展孕前优生服务,规范了海量家庭档案的管理。利用计算机辅助智能分析的方法,有效提升了服务人员的技术水平和工作效率,扩大了服务人群。结论:信息技术的应用,为科学评估育龄夫妇的生殖健康状况和生殖风险提供了可能,促进了出生缺陷的一级预防工作的开展,在信息化建设中应注意处理好几个重要环节,以加快我国人口和计划生育工作的信息化建设的步伐。     

上海市新婚人群对孕前检查需求调查

目的 了解上海市新婚对象接受孕前保健服务的意愿和相关需求。方法 自2011年4-6月,在上海市17个区县的婚姻登记点中抽取了1030对结婚登记的夫妇,通过问卷调查方式了解其基本情况,对孕前检查的期望和影响因素等。结果①新婚对象男女双方主要从事科教文卫等专业技术和行政管理工作;学历均以大专本科为主;双方户籍均以本市户籍为主,女方非本市户籍比例略高。②男女双方接受婚前检查的比例接近,分别为67.4%和69.2%;接受调查的对象中,有73.6%的夫妇尚无生育计划。③绝大多数对象希望通过孕前检查达到预防出生缺陷和保障孕妇安全的目的。④被调查人群对孕前检查的需求方面,有64.9%的人选择希望免费,66.2%的对象选择了希望在周末,90.3%的对象选择了愿意在妇幼保健机构进行检查。⑤对象最关注的是孕前检查的检查效果和服务质量。⑥对象了解孕前检查的途径以婚前检查时医师告知（64.9%）和同事朋友介绍（46.4%）为主。结论 对象以预防出生缺陷和保障孕妇安全作为孕前检查的主要目的,而检查的效果,服务质量是影响其是否参加的主要因素。把孕前检查设置在妇幼保健机构,安排在对象方便的时间和免除费用对检查有一定的促进力度。     

深圳市不同机构流产服务的现状及其评价

目的:了解和评价深圳市不同服务系统和不同等级医疗机构流产服务状况。方法:选择该市计划生育和卫生6家不同等级流产服务机构,采用现场观察和深入访谈等定性研究方法,了解相关设施设备、服务规范、服务记录状况以及流产服务提供过程,进行总结和评价。结果:各家机构设施设备良好,但部分机构手术室和观察室不能满足流产妇女隐私保护和舒适性需要。流产妇女基本能够知情后选择流产方法,但术前血常规和阴道分泌物检查存在一定的医患分歧。多数机构药物流产的有效性偏低(<91.7%),服务记录的内容和完整性尚有一定欠缺,医患交流不足,避孕服务缺乏积极主动。卫生机构流产妇女量经常超出其基础设施承受能力,技术人员相对不足,而计划生育机构流产妇女较少,服务资源利用不充分。结论:要加强机构管理者和技术人员流产优质服务的意识,特别要加强被服务者隐私保护和流产后计划生育服务。有必要积极探讨药物流产有效性偏低的原因,合理分流服务对象,提高计划生育机构流产服务资源利用率。     

Integrating HIV prevention and care services: the Seattle "Collaboration Project".

The "Collaboration Project" explored whether human immunodeficiency virus (HIV) prevention providers in Seattle-King County refer their HIV+ clients into care services and whether HIV care service providers discuss sex and drug use risk reduction or make referrals for clients with ongoing risk reduction needs. Data uncovered demographic disparities between provider populations that may impact cross-system collaboration, particularly regarding provider demographic reflectiveness of the consumers being served. Ninety percent of prevention providers referred clients to care services; only one quarter discussed sexual risk reduction, while half discussed drug use risk reduction. Knowledge of cross-system resources was generally high, although gaps emerged between providers in several resource areas. Based on these findings, several key changes have been implemented.     

Providing General and Preconception Health Care to Low Income Women in Family Planning Settings: Perception of Providers and Clients

This study examines both provider and client perceptions of the extent to which general health concerns are addressed in the context of publicly supported family planning care. A mail survey of family planning providers (n = 459) accepting Medicaid-covered clients in Arkansas and Alabama gathered data on reported actions and resource referral availability for ten categories of non-contraceptive health concerns. A telephone survey of recent family planning clients of these providers (n = 1991) gathered data on the presence of 16 health concerns and whether and how they were addressed by the family planning provider. Data were collected in 2006–2007. More than half (56%) of clients reported having one or more general health concerns. While 43% of those concerns had been discussed with the family planning providers, only 8% had been originally identified by these providers. Women with higher trust in physicians and usual sources of general health care were more likely to discuss their concerns. Of those concerns discussed, 39% were reportedly treated by the family planning provider. Similarly, over half of responding providers reported providing treatment for acute and chronic health conditions and counseling on health behaviors during family planning visits. Lack of familiarity with referral resources for uninsured clients was identified as a significant concern in the provision of care to these clients. Greater engagement by providers in identifying client health concerns and better integration of publicly supported family planning with other sources of health care for low income women could expand the existing potential for delivering preconception or general health care in these settings.     

Women's Perspectives on Family Planning Service Quality: An Exploration of Differences by Race, Ethnicity and Language

CONTEXT: Despite calls to make family planning services more responsive to the values, needs and preferences of clients, few studies have asked clients about their experiences or values, and most have used surveys framed by researchers', rather than clients', perspectives.
METHODS: Forty in-depth interviews exploring lifetime experiences with and values regarding services were conducted with 18–36-year-old women who visited family planning clinics in the San Francisco Bay Area in 2007. Women were categorized as black, white, English- or Spanish-speaking Latina, or of mixed ethnicity to allow examination of differences by racial, ethnic and language group. Interviews were audiotaped, transcribed and coded thematically; matrices were then used to compare the themes that emerged across the subgroups.
RESULTS: Eight themes emerged as important to women's views of services: service accessibility, information provision, attention to client comfort, providers' personalization of care, service organization, providers' empathy, technical quality of care and providers' respect for women's autonomy. Women reported that it was important to feel comfortable during visits, to feel that their decision-making autonomy was respected, to have providers show empathy and be nonjudgmental, and to see the same provider across visits. The only notable difference among racial, ethnic and language groups was that Spanish-speaking Latinas wanted to receive language-appropriate care and contraceptive information.
CONCLUSIONS: Future surveys of family planning service quality should include measures of the factors that women value in such care, and efforts to improve providers' communication and counseling skills should emphasize the personalization of services and respect for clients' autonomy.